Amsacrine belongs to the group of cancer-fighting medications called antineoplastics. Amsacrine is used to treat acute adult leukemia (cancer of the white blood cells) in people who have been treated previously with other cancer medications. Amsacrine kills cancer cells by interfering with their growth and reproduction.

Your doctor may have suggested this medication for conditions other than those listed in these drug information articles. As well, some forms of this medication may not be used for all of the conditions discussed here. If you have not discussed this with your doctor or are not sure why you are being given this medication, speak to your doctor.

The recommended dose and dosing schedule of amsacrine varies according to body size. It is injected into a vein through a site on your skin that has been specially prepared for this purpose. The dose is often injected once a day for 5 days and repeated every 3 to 4 weeks. When the white blood cell count is under control without medication after treatment with amsacrine, the person is said to be in remission.

While in remission, the dose of amsacrine is usually reduced and given every 4 to 8 weeks, depending on the number of white blood cells in the blood.

Many things can affect the dose of medication that a person needs, such as body weight, other medical conditions, and other medications. If your doctor has recommended a dose different from the ones listed here, do not change the way that you are using the medication without consulting your doctor.

Amsacrine is always given under the supervision of a doctor. Very careful handling of this medication is required. It is always given in a hospital or similar setting with access to sterile equipment for preparation.

It is important this medication be given exactly as recommended by your doctor. If you miss an appointment to receive amsacrine, contact your doctor as soon as possible to reschedule your appointment.

Your doctor may want you to drink extra fluids to help prevent kidney problems.

As well as interfering with the growth and reproduction of cancer cells, amsacrine can interfere with some of your normal cells. This can cause a number of side effects. Keep track of any side effects and report them to your doctor, as suggested in the section"What side effects are possible with this medication?"

Amsacrine should not be used by anyone who:

• is allergic to amsacrine or to any of the ingredients of the medication
• is allergic to acridine derivatives (e.g., acriflavine)
• has reduced levels of blood cells (bone marrow suppression) caused by medication or radiation therapy

Many medications can cause side effects. A side effect is an unwanted response to a medication when it is taken in normal doses. Side effects can be mild or severe, temporary or permanent. The side effects listed below are not experienced by everyone who takes this medication. If you are concerned about side effects, discuss the risks and benefits of this medication with your doctor.

The following side effects have been reported by at least 1% of people taking this medication. Many of these side effects can be managed, and some may go away on their own over time.

Contact your doctor if you experience these side effects and they are severe or bothersome. Your pharmacist may be able to advise you on managing side effects.

Although most of the side effects listed below don't happen very often, they could lead to serious problems if you do not check with your doctor or seek medical attention.

Check with your doctor as soon as possible if any of the following side effects occur:

• confusion
• painful or difficult urination
• signs of infection
• signs of liver damage (e.g., abdominal pain or tenderness, dark urine, yellow eyes or skin)
• sores, ulcers in the mouth or on the lips and tongue
• swollen, red, and tender area of infection around rectum with accumulation of pus
• unpredictable or sudden changes in emotions
• weakness and tiredness

Stop taking the medication and seek immediate medical attention if any of the following occur:

• abnormal heart rhythm or pounding heartbeat
• blurred vision
• chest pain or palpitations
• difficulty breathing
• difficulty swallowing
• seizures
• signs of heart failure
• signs of unusual bleeding (e.g., vomiting blood or coffee grinds-like substance, unusual bleeding or bruising, black or tarry stools, or blood in urine)

Some people may experience side effects other than those listed. Check with your doctor if you notice any symptom that worries you while you are taking this medication.

Before you begin using a medication, be sure to inform your doctor of any medical conditions or allergies you may have, any medications you are taking, whether you are pregnant or breast-feeding, and any other significant facts about your health. These factors may affect how you should use this medication.

Blood clotting: This medication can reduce the number of platelet cells in the blood. Platelets help the blood to clot, and a shortage could make you bleed more easily. Tell your doctor immediately if you notice any signs that your blood is not clotting as quickly as usual. Such symptoms may include black and tarry stools, blood in the urine, easy bruising, or cuts that won't stop bleeding. Your doctor will do blood tests regularly to monitor the number of specific types of blood cells in your blood.

Gout and kidney stones: Amsacrine may increase the levels of uric acid in the body, further increasing the risk for gout or kidney stones in people predisposed to these conditions. People with gout or a history of gout should discuss with their doctor how this medication may affect their medical condition, how their medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed. Report any unusual joint pain or swelling to your doctor as soon as possible.

Heart disease: Amsacrine can cause heart problems or abnormal heart rhythms in some people. People with low potassium levels, or those treated previously with other cancer medications called anthracyclines are more at risk for these problems. People with heart conditions or a history of heart problems should discuss with their doctor how this medication may affect their medical condition, how their medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.

Infection: In addition to killing cancer cells, this medication can reduce the number of cells that fight infection in the body (white blood cells). If possible, avoid contact with people who have contagious infections. Tell your doctor immediately if you begin to notice the signs of an infection such as fever or chills, severe diarrhea, shortness of breath, prolonged dizziness, headache, stiff neck, weight loss, or listlessness. Your doctor will do blood tests regularly to monitor the number of specific types of blood cells in your blood.

Kidney function: People with impaired kidney function or kidney disease may experience increased side effects from amsacrine. People with kidney problems should discuss with their doctor how this medication may affect their medical condition, how their medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.

Liver function: People with impaired liver function or liver disease may experience increased side effects from amsacrine. People with liver problems should discuss with their doctor how this medication may affect their medical condition, how their medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.

Pregnancy: There are no adequate studies of use of this medication by pregnant women. This medication should not be taken during pregnancy. If you become pregnant while taking this medication, contact your doctor immediately. Discuss reliable birth control with your doctor to avoid the possibility of pregnancy during treatment with this medication.

Breast-feeding: It is not known if amsacrine passes into breast milk. If you are a breast-feeding mother and are taking this medication, it may affect your baby. Talk to your doctor about whether you should continue breast-feeding.

Seniors: The safety and effectiveness of using this medication have not been established for seniors.

There may be an interaction between amsacrine and any of the following:

• digoxin
• echinacea
• leflunomide
• live virus vaccines
• other cancer medications
• pimecrolimus
• tacrolimus (topical)
• warfarin

If you are taking any of these medications, speak with your doctor or pharmacist. Depending on your specific circumstances, your doctor may want you to:

• stop taking one of the medications,
• change one of the medications to another,
• change how you are taking one or both of the medications, or
• leave everything as is.

An interaction between two medications does not always mean that you must stop taking one of them. Speak to your doctor about how any drug interactions are being managed or should be managed.

Medications other than those listed above may interact with this medication. Tell your doctor or prescriber about all prescription, over-the-counter (non-prescription), and herbal medications you are taking. Also tell them about any supplements you take. Since caffeine, alcohol, the nicotine from cigarettes, or street drugs can affect the action of many medications, you should let your prescriber know if you use them.